Social Services: Asking the Right Questions

By Anjum Altaf

It is remarkable that the governments of Pakistan and India have not been able to ensure essential social services for citizens – public health and education are in shambles. As a consequence, ill health and illiteracy mar the lives of millions – a human capital deficiency that diminishes the potential of all. The resources diverted to sustaining an ailing population are no longer available for productive investment.

This is not a far-fetched claim. Think of individuals who have to spend a good part of their income to buy treatment – they would have that much less left to invest in their own nourishment or in their children’s education.

What holds for individuals holds for countries as well. A recent study examines what has been termed the calorie consumption puzzle in India – real rural household incomes and expenditures have risen but malnutrition remains higher than in most sub-Saharan African countries that are poorer and slower growing.

Empirical analysis reveals that rapidly rising expenditures on essentials like health care, education, and transport absorb all the increases in total expenditures leaving money available for food unchanged. And expenditures on non-food essentials are rising because of declining supply of social services by the state – private substitutes being more expensive.

The consequences are visible – over 40 percent of children born in the Subcontinent suffer from stunting.

This gross negligence of the state prompts two questions. The first asks why the state has failed to ensure essential services. Many explanations do the rounds – incompetence, absence of political will, and lack of resources being the most popular. Any serious examination renders these implausible. A simpler explanation is that the provision of services remains a low priority for the state and the absence of effective political action has failed to raise the priority – in effect, ‘don’t ask, don’t get.’ We remain trapped in an equilibrium marked by empty state rhetoric and ineffective political action from or on behalf of citizens.

Take as an example the provision of clean water, something everyone knows is vital for good health and whose self-provision diverts household time and income from more productive uses. For years the state has promised clean water and for years citizens have acquiesced in the status quo.

Those who ignore the first question jump immediately to the second – How could services be better provided? Given the disillusion with the state, the answer almost inevitably is the private sector. The debate then gets hopelessly entangled in the ideological pros and cons of privatization.

Asking who should provide social services is misleading because it is an incomplete question. An example should help grasp the point. We often hear the question ‘What is the best diet?’ Any competent dietitian would caution that the appropriate question is ‘What is the best diet for each unique person?’

The same holds for privatization. The wrong question is ‘Who should provide a particular service?’ The right question is ‘How a service might best be provided under existing conditions?’ It is the context that is central – as it varies, so should the answer.

It is here that we run into a major problem that plagues our public policy – borrowing the ‘best practice’ of the day from the West and expecting the same results free from contextual constraints.

A brief history of the provision of water in London should illustrate the importance of context. Till the end of the 19th century, multiple private companies served various parts of the city. They were nationalized at the beginning of the 20th century and the state assumed responsibility for service provision. Towards the last quarter of the century the service was privatized again.

At the very least, one could conclude that there was no single solution deemed best for all times. Each alternative provided a solution good for the moment but gave rise eventually to issues that could not be resolved within the system itself. There were objective conditions that dictated changes in the modes of service delivery.

Summarizing drastically and emphasizing just one dimension for illustrative purposes, the evolution was as follows: There was local private response to localized heterogeneous demand; inevitably private providers cut corners to maximize profit leading to consumer complaints; the inability to regulate forced the state to take over operations; after an interval, bureaucratic inefficiencies led to deteriorating service, higher tariffs, and investment needs; privatization was the solution to overcome these. The major differences between stages one and three were that private firms had grown into global corporations, technological advances had made effective regulation possible, and the state had developed the competence to regulate the private sector.

We can ask the obvious question: Does the state in Pakistan and India that is unable to provide services itself have the wherewithal or the incentives to regulate effectively a profit-oriented private sector not comprised of angels? If not, would the cure not be worse than the disease?

It is not that there are no solutions; there are just no off-the-shelf ones that can be borrowed readily from other places. The bottom line is that the public needs to demand good service and policy makers need to comprehend the realities on the ground. They need to know the local conditions – social, economic, political, legal – to determine what is likely to work or not and they need to be faced with real consequences for poor performance.

Ideological hopes and preferences are not enough; neither are technological fixes. The political process needs to drive demand, educated analysis is required to respond to it, and accountability is necessary to provide the impetus for improvement. All three are weak at this point.

Anjum Altaf is Dean of the School of Humanities and Social Sciences at the Lahore University of Management Sciences. This op-ed appeared in Dawn on August 18, 2013 and is reproduced here with permission of the author.

3 Responses to “Social Services: Asking the Right Questions”

The ADB could have benefited from the emphasis upon outcomes and contexts. But they did not, and so make silly statements as: “even when it is agreed that the ultimate aim should be to drastically reduce Asia’s major deprivations, an agreed-upon list of such deprivations will be difficult to develop… This is one of the major dilemmas that the capability approach has had to grapple with.” The authors at ADB have a poor understanding of Sen’s work.